Delivering Better Care

Pre-eclampsia – a term no couple anticipating a child wants to hear. A hypertensive disorder of pregnancy, the condition can lead to impaired maternal organ function, seizures, and even death if left untreated. And it’s not a rare occurrence. Approximately one in every 10 women shows evidence of hypertension in pregnancy, and 3 percent of singleton pregnancies will be affected by preeclampsia. The risk increases for certain groups of women, including those with multiple pregnancies and those with coexisting medical conditions such as chronic hypertension and chronic kidney disease.

At the moment, pre-eclampsia is diagnosed by looking for evidence of hypertension along with one or more of:

• proteinuria (assessed with a protein:creatinine ratio or a 24-hour urine collection)
• evidence of maternal organ dysfunction (maternal symptoms,raised creatinine, elevated transaminases, thrombocytopenia, disseminated intravascular coagulation, or hemolysis)
• evidence of fetal growth restriction

“All of the methods we use to diagnose pre-eclampsia are nonspecific,” explains Kate Duhig. “Most are associated with maternal end-stage organ damage as a result of the disease.” Duhig is first author of a study that seeks to improve pre-eclampsia diagnosis (1). She and her colleagues found that measuring the concentration of placental growth factor (PlGF) in blood allowed them to diagnose the condition up to two days earlier than conventional methods.

Do those two days really make a difference? “Preterm disease can deteriorate very rapidly with serious consequences for both mother and baby,” says Duhig. “The ability to reach a diagnosis two days earlier can help determine the appropriate place and frequency of management – for example, whether a woman needs admission or transfer to a hospital with appropriate neonatal care facilities. It can also be important for guiding steroid administration for fetal lung maturity and timing of delivery of the baby (the only cure for the disease).”

Duhig’s study showed that by monitoring PlGF, a pathophysiologically relevant biomarker, women experienced fewer serious adverse events. Low PlGF (< 100pg/mL) has a high diagnostic accuracy for pre-eclampsia requiring delivery within 14 days, ensuring that women who need rapid treatment can be identified and assisted. Furthermore, researchers were able to reassure women who did not need investigation and intensive follow-up, minimizing unnecessary health resource use.